Healthcare Provider Details

I. General information

NPI: 1912833062
Provider Name (Legal Business Name): KIMBERLY RUTH GROMEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MIGHTY OAK LN
CHADDS FORD PA
19317-9655
US

IV. Provider business mailing address

4420 CHESTNUT ST UNIT B
PHILADELPHIA PA
19104-2914
US

V. Phone/Fax

Practice location:
  • Phone: 651-788-5837
  • Fax:
Mailing address:
  • Phone: 651-788-5837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31528
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: